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Malnutrition Workup

  • Author: Harohalli R Shashidhar, MD; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
 
Updated: Mar 10, 2016
 

Laboratory Studies

See the list below:

  • The most helpful laboratory studies in assessing malnutrition in a child are hematological studies and laboratory studies evaluating protein status.
    • Hematological studies should include a CBC count with RBC indices and a peripheral smear. This could also help exclude anemias from nutritional deficiencies such as iron, folate, and vitamin B-12 deficiencies.
    • Measures of protein nutritional status include serum albumin, retinol-binding protein, prealbumin, transferrin, creatinine, and BUN levels. Retinol-binding protein, prealbumin, and transferrin determinations are much better short-term indicators of protein status than albumin. However, in the field, a better measure of long-term malnutrition is serum albumin because of its longer half-life.
  • Additional diagnostic evaluation
    • In children who have a history of adequate food intake and signs/symptoms of malnutrition, focus on identifying the cause of malnutrition. Perform laboratory studies based on information from a complete history and physical examination.
    • Initial diagnostic laboratory studies include a CBC count, sedimentation rate, serum electrolytes, and urinalysis and culture. Stool specimens should be obtained if the child has a history of abnormal stools or stooling patterns or if the family uses an unreliable or questionable source of water.
    • Additional studies may focus on thyroid functions or sweat chloride tests, particularly if height velocity is abnormal. Further diagnostic studies should be determined as dictated by the history and physical examination. For example, lab tests evaluating renal function, such as phosphorus and calcium, should be obtained in the presence of renal symptoms. Children with suspected liver disease should have triglyceride and vitamin levels obtained, while zinc levels should be obtained in patients with chronic diarrhea.
  • Celiac serology is a useful screening test and should be considered, especially if there is a family history of celiac disease or if other autoimmune diseases, such as type I diabetes mellitus, are present.
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Other Tests

See the list below:

  • Practical nutritional assessment
    • Complete history, including a detailed dietary history
    • Growth measurements, including weight and length/height; head circumference in children younger than 3 years
    • Complete physical examination
  • Sensitive measures of nutritional status
    • Height-for-age or weight-for-height measurements greater than 2 standard deviations below the mean for age
    • Height-for-age or weight-for-height measurements more than 2 standard deviations less than the mean for age
    • Height-for-age measurements less than 95% of expected value
    • Height-for-height measurements less than 90% of expected value
    • Less than 5 cm/y of growth in children older than 2 years
    • Body mass index (BMI), although this is not established by the Centers for Disease Control and Prevention (CDC) as a criteria for failure to thrive
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Contributor Information and Disclosures
Author

Harohalli R Shashidhar, MD Associate Professor, Department of Pediatrics, Chief, Division of Pediatric Gastroenterology and Nutrition, University of Kentucky Medical Center

Harohalli R Shashidhar, MD is a member of the following medical societies: American Academy of Pediatrics, Kentucky Medical Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Coauthor(s)

Donna G Grigsby, MD Associate Professor, Department of Pediatrics, University of Kentucky College of Medicine

Donna G Grigsby, MD is a member of the following medical societies: Kentucky Chapter of The American Academy of Pediatrics, Kentucky Pediatric Society, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS, FAAP Professor of Pediatrics, Medical College of Georgia, Georgia Regents University; Chief, Division of Neonatology, Director, Fellowship Program in Neonatal-Perinatal Medicine, Director, Transport/ECMO/Nutrition, Vice Chair, Clinical Research, Department of Pediatrics, Children's Hospital of Georgia

Jatinder Bhatia, MBBS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, American Society for Nutrition, American Society for Parenteral and Enteral Nutrition, Academy of Nutrition and Dietetics, Society for Pediatric Research, Southern Society for Pediatric Research

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Gerber.

Additional Contributors

Maria Rebello Mascarenhas, MBBS Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief of Nutrition, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia

Maria Rebello Mascarenhas, MBBS is a member of the following medical societies: American Gastroenterological Association, American Society for Parenteral and Enteral Nutrition, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

References
  1. Balint JP. Physical findings in nutritional deficiencies. Pediatr Clin North Am. 1998 Feb. 45(1):245-60. [Medline].

  2. WHO. Malnutrition-The Global Picture. World Health Organization. Available at http://www.who.int/home-page/.

  3. Blossner, Monika, de Onis, Mercedes. Malnutrition: quantifying the health impact atnational and local levels. 2005. Available at http://whqlibdoc.who.int/publications/2005/9241591870.pdf.

  4. Hendricks KM, Duggan C, Gallagher L, et al. Malnutrition in hospitalized pediatric patients. Current prevalence. Arch Pediatr Adolesc Med. 1995 Oct. 149(10):1118-22. [Medline].

  5. Benitez-Bribiesca L, De la Rosa-Alvarez I, Mansilla-Olivares A. Dendritic spine pathology in infants with severe protein-calorie malnutrition. Pediatrics. 1999 Aug. 104(2):e21. [Medline].

  6. World Health Organization. WHA Global Nutrition Targets 2025: Low Birth Weight Policy Brief. World Health Organization. Available at http://www.who.int/nutrition/topics/globaltargets_lowbirthweight_policybrief.pdf. 2014;

  7. Mendez MA, Adair LS. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr. 1999 Aug. 129(8):1555-62. [Medline].

  8. Heywood AH, Marshall T, Heywood PF. Motor development and nutritional status of young children in Madang, Papua New Guinea. P N G Med J. 1991 Jun. 34(2):109-16. [Medline].

  9. Martorell R, Rivera J, Kaplowitz H, Pollitt E. Long-term consequences of growth retardation during early childhood. Hernandez M, Argente J. Human growth:basic and clinical aspects. Amsterdam: Elsevier Science Publishers; 1992. 143-149.

  10. De-Regil LM, Suchdev PS, Vist GE, Walleser S, Peña-Rosas JP. Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Cochrane Database Syst Rev. 2011 Sep 7. 9:CD008959. [Medline].

  11. Stobaugh HC, Ryan KN, Kennedy JA, Grise JB, Crocker AH, Thakwalakwa C, et al. Including whey protein and whey permeate in ready-to-use supplementary food improves recovery rates in children with moderate acute malnutrition: a randomized, double-blind clinical trial. Am J Clin Nutr. 2016 Mar. 103 (3):926-33. [Medline].

  12. US Department of Health and Human Services, US Department of Agriculture. Dietary guidelines for Americans, 2005. US Department of Health and Human Services. 2005.

  13. Zeng L, Dibley MJ, Cheng Y, et al. Impact of micronutrient supplementation during pregnancy on birth weight, duration of gestation, and perinatal mortality in rural western China: double blind cluster randomised controlled trial. BMJ. 2008 Nov 7. 337:a2001. [Medline].

  14. Roberfroid D, Huybregts L, Lanou H, et al. Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso. Am J Clin Nutr. 2008 Nov. 88(5):1330-40. [Medline].

  15. Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2008 Jul 16. CD005436. [Medline].

  16. Scrimgeour AG, Lukaski HC. Zinc and diarrheal disease: current status and future perspectives. Curr Opin Clin Nutr Metab Care. 2008 Nov. 11(6):711-7. [Medline].

  17. Barber J. Antibiotics Help in Malnutrition Treatment in Children. Medscape Medical News. Jan 30 2013. Available at http://www.medscape.com/viewarticle/778491. Accessed: February 5, 2013.

  18. Blecker U, Mehta DI, Davis R, et al. Nutritional problems in patients who have chronic disease. Pediatr Rev. 2000 Jan. 21(1):29-32. [Medline].

  19. Caulfield LE, de Onis M, Blossner M. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr. 2004 Jul. 80(1):193-8. [Medline].

  20. Chandra RK. 1990 McCollum Award lecture. Nutrition and immunity: lessons from the past and new insights into the future. Am J Clin Nutr. 1991 May. 53(5):1087-101. [Medline].

  21. de Onis M, Blossner M, Borghi E. Estimates of global prevalence of childhood underweight in 1990 and 2015. JAMA. 2004 Jun 2. 291(21):2600-6. [Medline].

  22. de Onis M, Frongillo EA, Blossner M. Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980. Bull World Health Organ. 2000. 78(10):1222-33. [Medline].

  23. Hay WW Jr, Lucas A, Heird WC, et al. Workshop summary: nutrition of the extremely low birth weight infant. Pediatrics. 1999 Dec. 104(6):1360-8. [Medline].

  24. Islam S, Abely M, Alam NH, et al. Water and electrolyte salvage in an animal model of dehydration and malnutrition. J Pediatr Gastroenterol Nutr. 2004 Jan. 38(1):27-33. [Medline].

  25. Kleinman RE, Murphy JM, Little M, et al. Hunger in children in the United States: potential behavioral and emotional correlates. Pediatrics. 1998 Jan. 101(1):E3. [Medline].

  26. Kleinmann R, Committee on Nutrition. Pediatric Nutrition Handbook. 4th ed. American Academy of Pediatrics; 1998.

  27. Koerner CB, Hays TL. Food allergy: current knowledge and future directions. Immunol Allergy Clin North Am. 1999. 19.

  28. Man WD, Weber M, Palmer A, Schneider G, Wadda R, Jaffar S. Nutritional status of children admitted to hospital with different diseases and its relationship to outcome in The Gambia, West Africa. Trop Med Int Health. 1998 Aug. 3(8):678-86. [Medline].

  29. Muller O, Krawinkel M. Malnutrition and health in developing countries. CMAJ. 2005 Aug 2. 173(3):279-86. [Medline].

  30. Rosenfield RL. Essentials of growth diagnosis. Endocrinol Metab Clin North Am. 1996 Sep. 25(3):743-58. [Medline].

  31. Trehan I, Goldbach HS, LaGrone LN, Meuli GJ, Wang RJ, Maleta KM, et al. Antibiotics as part of the management of severe acute malnutrition. N Engl J Med. 2013 Jan 31. 368(5):425-35. [Medline].

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Hormonal adaptation to the stress of malnutrition: The evolution of marasmus.
A classic example of a weight chart for a severely malnourished child.
This infant presented with symptoms indicative of a dietary protein deficiency, including edema and ridging of the toenails. Image courtesy of the Centers for Disease Control and Prevention.
This infant presented with symptoms indicative of Kwashiorkor, a dietary protein deficiency. Note the angular stomatitis indicative of an accompanying Vitamin B deficiency as well. Image courtesy of the Centers for Disease Control and Prevention.
 
 
 
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